What about using Patient Restraints?

DEFINITION OF RESTRAINTS

Physical Restraints: are any manual method or physical or mechanical device, material, or equipment attached or adjacent to the patient’s body that the individual cannot remove easily which restricts freedom of movement or normal access to one’s body. Examples include, but are not limited to, leg restraints, arm restraints, vest or jacket restraints, waist belts, geri-chairs, hand mitts, wheelchair safety bars, and lap pillows. Center practices which meet the definition of a restraint include tucking in a sheet so tightly that a patient cannot move, bedrails, or chairs that prevent a patient from rising, or placing a wheelchair bound patient so close to a wall that the wall prevents the patient from rising.

Chemical Restraints: Psychoactive drugs used to treat behavioral symptoms in place of good care, such as using them for discipline or staff convenience.

 

WHY USE RESTRAINTS?

 Physical Restraints: If a restraint is used to enable the patient to attain or maintain their highest practicable level of functioning then restraint use is justified. Some examples would include a half bed rail used by a partially paralyzed person to allow themselves to turn over in bed or a seat belt used to help remind double amputees that they cannot walk on missing legs (they may have the feeling that their legs are still there).

Chemical Restraints: Psychoactive medication may be given to treat a psychological condition, such as depression, that cannot be alleviated with restraint alternatives. Alternatives tried might include increased participation in activities, increased family visits and support, or 1:1 counseling with a social worker.

 

RISKS ASSOCIATED WITH RESTRAINT USE

Use of restraints can lead to possible negative outcomes such as decreased range of motion of the joints, decreased muscle tone, decreased ability to walk, lessened social contact, agitation, symptoms of depression or social withdrawal, incontinence and skin breakdown.

 

ALTERNATIVES TO RESTRAINT USE

•         Restorative nursing programs, such as walking, eating, toileting, bathing.

•         Correct wheelchairs that are in good working order and correct size for patient use.

•         Involvement in center activity programs to occupy patient’s time and attention.

•         Taped messages from family members to play when patient is agitated.

•         Toileting schedules for patients at risk to fall.

•         Using staff interventions and education to prevent triggering inappropriate behavioral responses from patients.

•         Use of safety devices that trigger an alarm when a wandering patient tries to leave a safe protected environment.

•         Use of body alarms that attach to chair or bed and alarm when patient tries to get up unassisted.

•         Use of a low bed.

The list of alternatives is endless. The key is to evaluate the patient and determine what plan of action can be put into place as an alternative to the use of a restraint.